Here's how to handle those curious patches of missing hair

A lot of us have patchy beards and curious bald spots, but those are just genetics at play. What about the guys who have more concentrated bald spots, right in the middle of a full beard or mane? That might be alopecia.

The science behind it is complicated, especially since one kind of alopecia differs so drastically from the next, and from one person to the next. While you need to visit your doctor to discuss any of your symptoms, there are still some basics you can learn prior to that appointment. To get a better grasp on the main types of alopecia that affect beards and hair, we sought the expertise of board-certified dermatologist Lindsey Bordone at Columbia University Medical Center and NY-Presbyterian.

There are different kinds of alopecia

There are many types of alopecia, as far ranging as hair loss that comes from pulling your hair back too tight (traction alopecia), as well as full-body hair loss (alopecia universalis) or all of the hair on the head (alopecia totalis).

Maybe you hadn’t realised this, but your standard-fare hair loss is, in fact, alopecia. It’s the most common type: Male- and female-pattern hair loss is known as androgenetic alopecia. Bordone clarifies that, in men, this manifests as thinning hair density atop the scalp, and/or recession at the front of the scalp.

The second most discussed type of alopecia is alopecia areata. It affects hair follicles and leads to bald spots, and is most common in people who have an autoimmune disease, like lupus, vitiligo, thyroid disease, type-1 diabetes, and colitis. For example, I myself have vitiligo, and some of the white patches of hair on my head and beard have turned to bald spots. It is also believed that alopecia areata can be brought on by stress. (There is another hair loss phenomenon called telogen effluvium that is stress-induced.)

One common form of alopecia areata is alopecia barbae, wherein the beard experiences patches of hair loss. Don’t confuse alopecia barbae with trichotillomania, which is the condition wherein a man stress-picks at his beard and injures the follicles. “Though this hair can regrow after being pulled, chronic injury can lead to a permanent decrease in density,” says Bordone.

Who gets alopecia?

Bordone says that genes play a large role in who gets androgenetic alopecia. “Both mother and father contribute their genetics and can determine whether their adult child will have a given hair density.” She adds that obesity and an unhealthy lifestyle will worsen hair loss, since these behaviours age the body biologically.

Many of the autoimmune diseases that lead to alopecia areata are also inherited through genetics, though not all of them. If you get alopecia there might be someone in your lineage with the same condition, even if it skipped your mom or dad before expressing itself in you.

Can alopecia be prevented or treated?

Androgenetic alopecia can be slowed, yes, through prescription pills, topical solutions, and healthy and active lifestyles. (We've got more advice on how to prevent hair loss.)

Alopecia areata is harder to predict, and thus prevent. You can speak with your dermatologist about different methods for fortifying and resuscitating the follicles before they become barren. (Even hair that appears lost can sometimes be salvaged, since the follicle is still intact for some time. Various procedures can revive the weak follicle and stimulate hair growth.) Options for alopecia areata patients include steroid injections, oral cortisone tablets, and a few topical solutions that strengthen follicles, like minoxidil (aka Rogaine, which is also effective on androgenetic alopecia), steroid creams, and more. Consult your board-certified dermatologist to discuss the best approach, and to safely track progress.

In either case, when treatment is successful, “Some of the hairs that were miniaturising can increase in density,” says Bordone. “[When it works], this can give the impression that hair has grown back.”

What about side effects?

One of the common treatments for androgenetic alopecia, Propecia (aka finasteride), is sometimes associated with a decreased libido in men, says Bordone. “This is uncommon and should resolve once the medication is stopped, and any remaining Propecia is metabolised and washed out if a patient’s system.” Just keep close track of the process, and speak with your doctor immediately if you notice anything suspect.

Many of the treatment options for alopecia areata (on the head or beard) are high risk, since they include chemicals or steroids. Again, your doctor is your best friend through this process.

OK, what about hair transplants?

“Hair transplants could help an area of androgenetic alopecia but would not help improve hair density in inflammatory types of hair loss (alopecia areata),” says Bordone.